Achilles Tendinopathy Toolkit: Section F - Medical and Surgical Interventions

Achilles Tendinopathy: Medical and Surgical Interventions

The purpose of this document is to summarize common medical and surgical interventions which may be considered for the management of Achilles tendinopathy – particularly if it is not responding adequately to more strongly supported conservative management strategies (see “Achilles Tendinopathy: Summary of the Evidence for Physical Therapy Interventions”).

Pharmacological Approaches

NSAIDS

Method		Short term benefit in the acute stage of tendinopathy to minimise inflammatory process.
Proposed Mechanism		Interrupts the chemical pathway of inflammation.
Benefit: Pros/Cons	Pros:	Inexpensive, easily accessible.
	Cons:	Precautions and contraindications that accompany specific medications. Inhibition of inflammation may delay soft tissue repair by impairing fibroblastic proliferation.
Evidence		Weak evidence for a modest effect in acute stage in Achilles tendinopathy. Recommendation for a short course of NSAIDs for acute symptoms within 14 days. No difference between oral or topical application.
Take Home Message 'Implications for Physiotherapy		PTs are involved in the treatment of tendon pain at all stages of recovery. General knowledge of commonly used NSAIDS is important for treatment planning.

Corticosteroid (injection)

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Glycerol Trinitrate (GTN)

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Injection Therapies

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Polidocanol

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Prolotherapy

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Platelet Rich Plasma (PRP) and Autologous whole blood

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

High volume injection (HVI) or Hydrostatic dissection

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Dry Needling

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Dry Needline using a Hypordermic Needle ("tendon fenestration")

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Surgical Approaches

Percutaneous tenetomy

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Surgical debridement

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Minimally invasive stripping

Method
Proposed Mechanism
Benefit: Pros/Cons	Pros:
	Cons:
Evidence
Take Home Message 'Implications for Physiotherapy

Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012.